For Future Doctors: Step by step approach to subspeciality in Medicine

For Future Doctors: Step by step approach to subspeciality in Medicine

I received a lot of queries regarding the steps and timeline to do subspeciality in Malaysia from various budding doctors who are about to complete their undergraduate degree. Even though I have mentioned some of the steps in my earlier articles under the “For Future Doctors” series, somehow a more detailed explanation seem to be warranted. So, in this post I will write in detail on how to become a Physician and subsequently a subspecialist. I will not touch on surgical speciality.I will write this article in a “frequently asked question” format based on questions that was asked by these budding doctors in my blog.

1) What is MRCP?

MRCP (UK) is a diploma offered by Royal College of Physicians of the United Kingdom. In UK, it is an entrance exam to speciality and everyone needs to pass MRCP in order to pursue their speciality training. In Malaysia, MRCP is considered as an exit exam where upon finishing the exam and completing 18 months gazettement process, you will be considered as a General Physician. MRCP is an internationally recognised degree and widely accepted worldwide.

2) How is MRCP conducted?

MRCP consist of 3 parts. MRCP Part 1 consists of 2 papers of 100 questions each. It covers basic science as well as clinical questions. The questions are multiple choice questions (MCQ) with “best of five” answers. You are eligible to sit for MRCP Part 1, 12 months after your graduation and medically employed. This means that you need to complete at least 1 year of housemanship before sitting for MRCP Part 1.

After passing your MRCP part 1, you will be given 7 years to clear your Part 2(written) and Part 2 (clinical). You can sit for either of the Part 2 exams at any time. If you fail to clear both this exams within 7 years, you will have to sit for Part 1 again.

Part 2 (written) consists of 3 papers of 90 questions each. The questions are multiple choice questions (MCQ) with “best of five” answers.

Part 2 (clinical) is a clinical/practical exam. It consist of 5 stations assessing you on history taking, physical examination, making a diagnosis, investigations, management and communication skills. Station 1 and 3 will have real patients with physical signs of cardiovascular, respiratory, abdomen and neurology. Station 2 is on history taking and Station 4 will be on communication skills of explaining certain medical diagnosis to patients etc. Station 5 consists of 2 brief clinical scenarios where you have to take a brief history and do quick physical examination and come to a diagnosis, simulating a scenario in a day to day clinic.

3) What are the passing rates of MRCP?

Generally, the passing rate of each part of MRCP is about 45-50% worldwide. Very rarely, a person passes all the part in first try.

4) How long will I take to clear MRCP?

If you pass all the parts in first try, you can complete the MRCP in less than 5 years; the best will be 4 years after graduation.

5) What are the other options in becoming a Physician?

The only other option in becoming a Physician is to do local Master’s programme by UM, UKM or USM.

6) I planned to work in medium-sized hospital in Sabah or Sarawak to learn as much as I can without too much competition (HO overflow). but your advice is after I pass part 1 and 2 MRCP, I should apply for transfer to bigger hospital for training purposes to handle part 3, even if I’m in a rural hospital?

First of all, there are only few hospitals in Sabah and Sarawak which can take housemen, namely Kuching, Miri, Sibu, probably Bintulu soon, Queen E and probably Sandakan/Tawau hospitals soon. Rest of the hospitals do not have consultants to supervise housemen. As long as the hospital have consultants and has adequate training facilities for junior doctors, you should be able to sit for MRCP. Unfortunately, only major hospitals have adequate specialities for you to train as a physician. You must understand that MRCP is not just an exam for you to sit and pass without adequate clinical knowledge. You can sit and memorise all the textbooks but you will not be able to pass MRCP if you do not practise clinical skills. As far as possible, you need to undergo rotations in various subspeciality units to get adequate clinical knowledge before sitting for MRCP. Rural hospitals do not have subspeciality units for your training. That’s the reason, it is better to do your training in big general hospitals.

Furthermore, you need a supervisor who can testify that you are fit to sit for the exam, especially for Part 2. Thus, you need a proposer who can certify that you have undergone adequate training to sit for the exams. After passing all the parts, you also need a MRCP holder of at least 8 years to sign the testimony to receive the diploma.

7) What is gazzetment process?

Since MRCP is not a specialist exam in UK, Ministry of Health of Malaysia has made it compulsory for you to complete 18 months of gazzettment process before being recognised as a specialist and to receive the specialist allowance. Thus, after 18 months of further training in a tertiary hospital, you will have to get your HOD to recommend you to be gazzeted as a specialist. The gazzettement period can be shorter on a case by case basis depending on your duration of training before passing MRCP. This will be decide by MOH gazzettement committee.

8) After the gazzetement, what’s next?
How do I apply for sub-specialty training? Where do I apply? Can I apply while I’m still under the gazzetement process? Will I be accepted as soon as I apply, or it’s subjected to seats availability? In short, I would like to know about the sub-specialty training, and maybe as specific examples, you can tell me the route on to cardiologist and neurologist.

After gazzetement, you can apply for subspeciality training via Ministry of Health. Depending on the field of subspeciality that you are applying, the waiting time can vary from few months to few years. Popular fields like cardiology and gastroenterology take the longest time to get a training post. At the moment, subspeciality training in Malaysia can only be done in Ministry of Health hospitals or University hospitals. Only certain hospitals are designated for certain training. For example, cardiology training can be done at Penang Hospital, Serdang, Kuching and JB, as far as I know. Neurology is usually done in HKL and Penang.

Most subspeciality training in medicine is for 3 years. Usually, you need to do the training in 2 different centres. The final year can be done as an attachment overseas and you may be given a fully paid scholarship by MOH. From 2011 onwards, you need to sign a contract upon confirmation of your training post in subspeciality by MOH. You will be bonded for 3-5 years depending whether you do all your training locally or partially overseas. Previously, you are only bonded if you choose to go overseas during your final year.

All in all, it will take roughly 10-12 years upon graduation for you to become a subspecialist.

9) If I got accepted by Singapore as MO post-MRCP, is it certain that I will be absorbed into the sub-specialty training after 1 year? After I have completed my specialist training in Singapore, is my license recognized in Malaysia, and is my license recognized internationally for that matter.

There is no guarantee that you will get the subspeciality training post in Singapore. It depends on your performance and which field that you are choosing. If you stay long enough, you will get it, as long as you show interest and your superiors support you. Subspecialist training in Singapore is a very structured training programme and well recognised internationally. There is no problem for you to return to Malaysia as a subspecialist.

This is a difficult question to answer. Whether another country recognises our subspeciality training depends on that particular country. Generally, our local Master’s programme is NOT recognised elsewhere except for some Middle East countries. So, it is very likely that as a Master’s holder, you will not be able to work elsewhere as a specialist except on attachment basis. Certain countries like Australia have their College of Physicians to assess the particular consultants experience and then will decide whether you can be recognised as a sub-specialist.

11) What is FRCP?

After 8 years of holding MRCP (UK), you can apply to the respective college for FRCP(fellow of the royal college of physician). To be accepted into a college as a fellow, you need to have contributed a lot to clinical medicine and medical educations. Publications in journals are also important. Furthermore, you need a proposer who is a FRCP holder to propose you to be accepted as a fellow. The respective college councils will go through your CV and publications before deciding whether you can be accepted as a fellow. Being a FRCP holder gives you an international recognition in medical field.

all major general hospitals in each state are good for training. However, there are not many MRCP holders of more than 8 years around in gov hospitals. The senior ones are still around but about to retire.

Dr P,
thanks very much for this post – it shed some light on this mrcp business. i wonder though, why is the passing rate low (45-50%) when in the UK, all junior doctors (foundation year 1) need to pass this exam to get into specialist training? does this mean that the passing rate is high in the UK where the exam originates from?

The passing rate is generally the same as the exam is held almost simultaneously all over the world. The only advantage in UK is that they can sit for the exam 3 times/year and the fee is affordable for doctors working in UK. They also have good MRCP courses conducted by various hospitals and universities in UK. Where as over here, the exam is conducted once a year in Malaysia and once a year in Singapore. The exam fee is around 555 pounds each for Part 1 and 2 (written ) and 1100 pounds for Part 2 (clinical)!! That’s almost a month’s salary per sitting! That’s one of the reason why we cannot afford to sit for the exam as many times as we like. Definately, if we sit many times, the chances of passing is higher.

Thanks for the clarrifications. Yes , I do remember now that the specialist allowance was backdated 6 months upon gazzettement. “Selective Amnesia!”
As you said, generally we take it as 18 months of gazzettement.

Hi Dr P,
Firstly I am really happy and ‘lucky’ to come across your web page. It is really informative and rich in substance. Thank you so much Dr P.
I am currently pursuing my doctorate in public health (by default) in one of our local unis. I wish to stress at this point that my area of interest was and will always be Occupational Medicine. Unfortunately our country doesn’t recognize this field as a sub-specialty nor occupational physicians in the clinical aspect. Most of them end up in some state/district health office as public health doctors confined to administrative duties. To make matters worse certificate courses being conferred by NIOSH (9 day courses!!) to GP’s have subsequently resulted in ‘questionable’ credibility of occupational health doctors out in the field. Initially there was a MPH(occupational Health)-4 yr programme offered by UM and USM, unfortunately now they have so called ‘upgraded’ it to a doctorate programme in general public health. Most of us were aghast with the MOH’s abrupt overnight decision to transform the MPH(OH) into a Public Health Doctorate programme. End of the day we get conferred a Public Health Specialist status which sounds good on paper but prospect of becoming credible a OH physician becomes hampered. I am keeping my options open in Australia and New Zealand on practicing OH in their setup. If you have any info on my taking another accredited OH degree or practicing OH in another country who may really appreciate my services pls be free to let me know.

I am not sure what actually happened but I think the reason why they seem to have changed the system is probably to make you recognisable as a specialist and to be eligible to receive a full specialist allowance. But I must agree that it is a regressive approach. Even with our Master’s in public health, I don’t think you can work in Australia/NZ. Probably you can try Master’s in Occupational Health from NUS singapore, which do offer part time course. I am not sure whether it is recognised overseas.

this is my third time writing the same comment because i’m really doubtful as to whether the first two comments had actually reach you.

thank you again for answering and clearing my doubts, and i would like to find out more about the following:

– can you explain further as to what you meant by saying the system in singapore is more “structured”. meaning one will be offered a further sub-specialty training not only according to level of performance, but also the seniority (as long as i stick around long enough). and there will be no discrimination between oppurtunities offered to singaporean and malaysian? i’m just making guesses, and hence i would like to know more on this matter, as i have read that you have worked in singapore before too. if this is a good oppurtunity, i’m seriously considering it.

– after i got my gazzetement as an internal medicine specialist (physician) in malaysia post-MRCP, can i work in private as a physician, or open up a clinic to treat patient as a physician without acquiring further sub-specialization?

– where do i apply to after i got my MRCP if i want to work in singapore? i mean, this is application directed to a particular hospital, or to the ministry of health of singapore in general? where can i get more information regarding this process?

1) please read my article on ” Back from the future: from first world to third world” which is available in my MY MMA articles page. I have mentioned about the structured training programme in Singapore. Of course, citizens will be given priority. That happens everywhere. Even in Malaysia, foreigners are not allowed into out subspeciality programme, including PRs.

2) Yes, after gazzettement as a General physician, you can practise in private as a specialist withour subspeciality. However, the prospect will not be that great when you have so many subspecialist around you to compete with.

I stumbled across your blog as I was searching about prospects of returning to Malaysia to work as a doctor. I have to say, after reading some of your postings, I have a rather bleak picture now.

I am currently in a pretty good specialist training job in the UK. I’m enjoying the training opportunities, better working hours, lifestyle & better pay. However I do miss my family in Malaysia.

Hence I planned to finish my specialist exams here, work a year as a Registrar to gain experience & then move back to Malaysia.

I know I will have to work for the government for a few years, but I thought, atleast then I could work in my chosen speciality, rather than start off as a houseman again. I might have been naive thinking this, as I never really did any research on this.

Yes, thats sort of the plan. I’m not government sponsored. However Paediatric Specialisation in the UK is 8 years (until you qualify to be a Consultant). Seems a long time. By the end of your 3rd year, you are expected to have passed the MRCPCH clinical. So that is what I am aiming to do. I don’t know if I will then (after only 3-4 years of training) be able to come back to Malaysia & work as a Paediatric specialist, or if I would need to complete my 8 years of training here. Any idea? Thanks for your advice.

Finish all your training before coming back. Get your CST (or whatever the new name for it is now) before coming back, because that allows you to go back to the UK or Aus/NZ or Singapore and work as a specialist, in case you ever want to. Just having the MRCPCh alone is worthless – except in Malaysia.

This is not about double standard. As a JPA scholar, you are paid by the country using tax payers money. You are bonded for 10 years. Thus, it is only right for you to return and serve the government. JPA do allow you to stay back for about 4 years after which you must come home. If not, you will be blacklisted and any future scholarship for your siblings or your children will be denied. Furthermore, you also need to pay back certain amount of money, if not , your gurantors need to pay!

Some sponsors require the scholars to return to Malaysia as soon as they finish their medical degree. Hence it is a legal/ethical requirement for them to return to Malaysia.

In terms of the training in Malaysia, I can’t personally comment, as I have never worked there as a doctor.

I know that doctors in Malaysia get a lot more hands-on experience earlier. I sometimes worry that working in the UK, especially since the 48 hour European Work Time Directive, my training would not be as good as my Malaysian counterparts as I would not be working as many hours as them, hence not getting as much experience as them.

For patients here, it is great for them as they can expect to have someone that is skilled & experienced doing their procedure. For the junior doctors, it can be frustrating, not getting the opportunity to do it ourselves as the more senior doctors also are trying to get as much experience as they can, sometimes at your expense.

Every system has it flaws. I may come back to Malaysia with excellent doctor-patient communication skills but will I be as skilled a doctor? I’m not too sure.

Yes, you are absolutely correct. Malaysian training system is flawed in the sense that it is not well structured and mainly service based. However, in terms of Hands-on, you will learn much more in Malaysia. You may be more academic in UK rather than clinical base in Malaysia. I have seen specialist trained in UK/US who are unable to carry out simple procedures like inserting chest tube/CVP etc which is very commonly done by HO/MO in Malaysia. The only problem in Malaysia is that you do not get proper supervision and it is entirely up to you on how you want to be trained!

Let me throw another point of view in here. I am of the opinion that all govt scholars (be it JPA or MARA) should be allowed to complete postgrad training in the countries they graduate from with their own funding, before coming home. Only those from English-speaking developed countries should be allowed to do this.

They should be allowed 3-4 years to get onto specialty training, after which they should be allowed a certain time period to complete their training. If they fail to get on to training, or once they’ve completed it, they should come home and serve the govt for 10 years. My reasons:

1. Postgrad training spaces in Malaysia are limited.
2. We are not short of HOs, we are short of specialists in the govt sector.
3. These scholars will bring back the experience of working overseas with them – hopefully enriching the wider medical community in Malaysia
4. Sponsored students are mainly Bumiputeras – there is no doubt about that. Anecdotally, I have been told of racial discrimination in selection for the Masters programmes. Those that claim that, would have less high-achieving Bumi candidates to compete against if they were to stay overseas and train elsewhere.
5. These scholars would still come home and serve the govt, only their entry point would differ.
6. There are ENOUGH HOs already graduating and looking for jobs in Malaysia. Bring these overseas scholars back straight away would make it worse.

Thank you for raising the question about hands-on experience. For one, I am not a government sponsored student, but it seems that you are hypocritical/inconsistent in this subject.

If hands-on practical experience, as you say is a bonus in a training program, then why are you discouraging the average junior doctor from training in Malaysia?

Afterall we have to weigh whether structure is more valuable than “procedural experience”. If the latter is of more importance, why don’t we just train our specialists in Bangladesh, than bothering to take the MRCP?

In the changing nature of medical practice (in Malaysia at least) from a general service provision to greater subspecialisation and the need for further systemic reform, I do not foresee the greater need for doctors who are trained to do thousands of phlebotomy or hundreds of chest tubes or lumbar puncture.

Yes we need doctors who are able to do procedures competently, but we need to be realistic that procedural competency is not a substitute for clinical competency and leadership. These are peripheral competencies that can be relearned and retrained.

More importantly we need more doctors who can think analytically, practice safely, apply research evidence into their practice, and contributing academically/clinically into their discipline. That is more concerning as we have a glut of medical graduates now.

I humbly think that we need more clinical leaders who would be able to contribute to reducing the incidence of empyema, not more experts in chest tube insertion.

We have enough of “Yes-man” service MOs in our system that will happily treat the masses but not think outside the box. Instead of perfecting the art of doing chest drains, why do we get so many severe chest infections at the first place and see how we can prevent them or how can we treat them earlier and better?

We sorely need people who can bring fresh ideas, challenge current practices and strategically bring the medical discipline forward. That certainly doesn’t come from doing more phlebotomy.

Hence those who have the opportunity to train in world-class centres should be encouraged to do so, regardless of whether they are self-sponsored or not. The fact that they are already in world class institutions, show that they have the talent and potential for greater leadership in their disciplines.

The practical aspect of enforcing/honouring the contract can be done anytime after the postgraduate training, as long as there is proper tracking system and political will to do so. Sadly we have none of both.

To deny anyone from equal opportunities for the sake of sink-plugging an inefficient and flawed recruitment/training system in Malaysia is unacceptable.

I think you are not getting the point! You can’t compare the system in Uk and Malaysia. The field of medicine is so wide apart between these two countries. As I have said before, every system has flaws but you need to know what is more important in each system. In Malaysia, the flaw is the lack of structured training system but if you are enthusiastic, you will learn far more than what you will learn in UK. You can be a very good academic consultant but that does not make you a good doctor. Both clinical and procedural competency is important if you are going to work in malaysia, especially in smaller hospitals where there are no superiors to teach you!! There is no point of diagnosing a tension pneumothorax but can’t insert a chest tube. The patient will still die and your clinical knowledge is not going to safe him/her!! However, I do admit that less emphasis is given to academic progress in Malaysia. BUT whatever said and done, you will know what I am talking about when yoy start to work in Malaysia. The system is totally different and it will probably take another 50-100 years before Malaysia reach the similar status as UK/Australia/developed countries.

I never discouraged people from doing speciality whever they want. Whether you are trained locally or overseas, it DOES NOT matter. What I have been saying all this while is try to get an internationally recognised degree, mainly for your future prospects and job oppurtunities. You can still train in Malaysia or even in Bangladesh and sit for MRCP etc. YOu do not need to go to UK to train for MRCP!! Of course , same cannot be said for surgical fields.

AS for gov scholars, my stand has always been the same. Since you are paid by tax payers money, pls come back and serve the country. That’s the reason I totally support the fact that there is no need for the gov to send students overseas anymore since we have 31 medical schools in the country!! From my experience, most self sponsored students never return to Malaysia unless it is due to family reasons!

For Part 1, it does not matter where you are but it does matter for Part 2. However, to take all 3 exams, you must be out of your mind!! You must understand that these are not easy exams like your undergraduate exams! It takes a lot preparation and commitment. Furthermore, it is NOT cheap. Each part will cost you about RM2500-5000!!

The private sector is getting saturated. Many doctors are finding it difficult to survive. I am sure you know by now that private hospitals DO NOT pay you a salary!!

Dear sir,
looks like at least the government is some break to med sch overflow for the time being……sigh….anyway

I heard there is a board of specialist registrar to govern such post grad qualification of any specialty.
How active are they in monitoring the post-grad qualification? Since we have many surplus doctors, eventually they will choose to be a specialist, which what the government wants …. which i hope will not produce surplus specialist?

Also is there a quota for bumi for local uni post grad? As there is only 4-5 such local public uni offering post-grad

Can you write a blog to advice for those seek info for post grad in medical base and surgical base?

National specialist register started in 2006 to register all specialist and they do have a list of recognised postgraduate degrees. Please visit their website http://www.nsr.gov.my. Yes, there is a quota system for local Master’s programme. There are only a total of 800 seats offered for this years’s local Master’s programme which includes all disciplines. It is way too small a number compared to the number of doctors graduating. They are planning to increase it to 1000 by 2015 but frankly the quality of graduates are also declining slowly. The blog post you just read is about post grad in medical base and hopefully I will write something about surgical field later.

thank you for your enlighting information doctor! this is my first time reading ur blog, and i consider myself lucky!! this blog is so informative, thank u!
I have a few questions, if i m working in singapore as a MO (malaysian), is it better to do MRCP in malaysia or singapore? and how likely is the chances to do MRCP in singapore? let’s say to complete MRCP in 4-5 yrs duration, in between that duration, can i transfer from one hospital to another? lets say from malaysia – singapore.
i m a final yr medical student and hoping to do HO in singapore, but my uni is not under the “recognised medical institution” list by SMC.. what other ways to work there?
what other hospital in msia do u recommend for HO? and why?

If your degree is not recognised than it is better that you get your MRCP in Malaysia before going to Singapore. If not you need to sit for the entrance exam at NUS. Any general hospital in Malaysia is OK for HO as long as you are interested in learning. email: pagal72@gmail.com

Dear dr. Pagalavan,
I have completed my mrcp exams last june n put in my gazettement papers once my results were out early in august. This was done at the head office in putrajaya… Since then i’ve been working in the cardiology department of a regional referral centre. According to the matron at the head office, the gazettement started from the date i had reported for duty after the exams. In thelast week of december i receive a letter of transfer to a hospital in jb. Upon taking up the post, my new head of department raised questions on who is going to sign for the past seven months n that my gazettement should start from the date of me reporting now.. Which is seven months later… This was very disheartening… Why is there no clear cut circulars on this.. Why was i not given an earlier date for transfer if this was true… Who should i bring this matter to? For someone who has a keen interest in cardiology, i’ve waited patiently but if this is how moh is going to treat its loyal servants then there is no point waiting… Some of my friends have left n joined singapore n ijn… How come the sub training in ijn does not require the gazettement? Why is there a discrepancy? To add salt to the wound the sub training at moh is not even recognized elsewhere…

Please advise as i’m distressed, disheartened n at a loss at the moment… Thank you.

Technically, your gazettement starts from the day you start your posting in the department/hospital that MOH sends you for gazettement. However, generally, the date of gazettment is taken from the date of passing your MRCP. You can contact Bahagian Perkembangan Perubatan for further info.

As long as you are a civil servant, you will face this kind of problems. Nothing new. You just have to put up with it.

Yes, you can resign and join IJN but you may have problems being gazetted as a general physician later. You may be gazetted as a cardiologist but NOT for internal medicine under NSR. That is the reason it is better to be gazetted first before going to singapore or IJN. Otherwise you either stay on in IJN or can only practise cardiology in private sector.

I’m a 6th poster HO in a small MOH hospital. I’m interested in pursuing psychiatry. I’ve read through a few of your posts regarding the reality of our healthcare system (of which will be more competitive than ever due to surge of HO) is it necessary for me to sit for MRCP – just to make sure that i’m able to survive the competition? Or in other words, so that i can have a secure prospect in my career in future.

Is it recommendable for me to do so? Or i just have to apply to become MO in Psy dept, then proceed with master programme?

usually, Master’s in Psychiatry is quite easy to get in as the number of applicants is usually not many. There is no point doing MRCP when your interest is in psychiatry. Furthermore, MRCP is not an easy exam either and it is also expensive.

I am a mo working in a Klinik Kesihatan which has a FMS. I have passed my MRCP part one last year and I have been trying to get a transfer ever since. However, JKN kept giving me the excuse of not enough Drs and asked me to stay longer. My question is since becoming a physician requires one to be in medical posting for at least 4 years, can my posting in district be considered part of the 4 years?

I am a Cardiff University graduate in Year 2010 and is currently a Senior House Officer in one of the hospitals in Wales. I have passed my Part 1 MRCP and is waiting for sit for my Part 2 in December.

I am originally from Kuching, Sarawak. I have always wanted to pursue Cardiology as a career. Since Kuching is a training centre for Cardiology, I am very enticed to return to Kuching for my subspecialist training.

Would you recommend me to pursue my Cardiology training in the UK or is the standard similar to returning to Kuching to train? Specialist training in the UK is about 6 years.

I am torn between being close with my family and my training. The thought of settling down with a family has crossed my mind many times.

In Malaysia, you can’t go into cardiology training immediately after passing PACES. You need to undergo 18 months of gazettement process before applying for subspeciality training. Cardiology subspeciality training will be another 3 years.So, the total time taken will be around the same. The quality is about the same.

Dear Pagalavan, thank you for your advice and opinion. I have just spoken to my mum over the phone this weekend and I think we are of the concensus I will return to Malaysia after my MRCP to be near family and to serve the country. As you said, the quality of training is almost similar between the UK and Malaysia. I am a Christian and a strong believer that God can use me in places He sent me to. I do not need a world recognised CCT certificate to serve the people. At the moment, I do not feel called to pursue my registrar training in the UK. I have many friends here, as the matter of fact, most of my best buddies are Welsh and brothers and sisters I have met in church. But sometimes, we may have to leave the good things behind and perhaps the door will open for a better future with God by my side.

Dear GP, cardiology is one of the more competitive training jobs to secure. But if you have a strong CV such as a number of peer-reviewed publications, poster presentations, teaching experience, you do stand a chance of getting a training number. However, you need to be in the training system already as a senior house officer in order to apply for registrar training. If you are no non-EU trainee, you must sit for PLAB first in order to work in the UK. I have a few Indian friends who have done that. The major difficulty most non-EU trainees encounter is knowing the hospital system. I have done a few Cardiology jobs in the UK including the largest tertiary hospital in Wales as a Senior House Officer and I have enjoyed all of them despite the crazily busy schedule everyday. I wish you all the best if you are hoping to pursue Cardiology training in the UK.